Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceBRAF V600E mutations are frequently associated with aggressive papillary thyroid carcinomas (PTCs), yet tumors with low allele frequency (AF) are often considered to be indolent. However, exceptions exist, suggesting additional factors may influence tumor behavior. Gene expression alterations (GEA) may help identify tumors with more aggressive molecular phenotypes.ObjectiveTo evaluate whether aggressive clinicopathologic features are associated with GEA positivity in low AF BRAF V600E-mutated PTCs.DesignRetrospective cohort study.SettingTwo McGill University Academic Hospitals, 2019 to 2024.ParticipantsPatients with PTC harboring BRAF V600E (AF ≤ 25%) who underwent preoperative testing.Intervention or ExposureLow AF BRAF V600E mutation (≤25%) characterized using ThyroSeq v3 genomic classifier.Main Outcome MeasuresThe primary outcome was GEA status. Tumor aggressiveness (defined by extrathyroidal extension, lymph node metastasis, lymphovascular invasion, high-risk histology, or aggressive variants), Bethesda classification, and AF were evaluated as predictors of GEA using logistic regression. Stratified analysis was performed based on AF (≤10% vs. >10%).ResultsAmong 49 patients identified (mean age 49 ± 14 years; 86% female; mean AF 11% ± 8%), 73% (36/49) had aggressive features and 61% (30/49) had GEA-positive tumors. Among GEA-positive tumors, 80% (24/30) were classified as aggressive and had a significantly-higher median AF (16.5%) than GEA-negative tumors (P = .0003). Stratified analysis showed that Bethesda VI nodules significantly predicted GEA positivity in tumors with AF > 10% (P = .03).ConclusionIn low AF BRAF V600E-mutated PTCs, GEA positivity is associated with high-risk cytology, higher AF, and aggressive tumor features.RelevanceGEA may be a useful molecular marker of aggressive tumor biology in low AF PTCs and holds potential as a complementary tool for preoperative risk stratification.

ImportanceGlottal competence and cough effectiveness are associated with aspiration. In unilateral vocal fold paralysis (UVFP), injection laryngoplasty (IL) is the mainstay treatment for those with dysphonia and dysphagia. However, few data exist explaining how IL exerts its effects on aspiration prevention.ObjectiveTo evaluate the effect of IL on voluntary cough strength, glottal closure, and swallowing function. Furthermore, the effects were compared between patients with active treatment/disease and those without.Study DesignProspective cohort study.SettingLaryngology clinic of single tertiary hospital.ParticipantAdult patients underwent IL for UVFP between January 2021 and April 2023.Main Outcome MeasuresMaximum volitional cough pressure (MCoughP) was quantified before and after IL, as well as clinical voice outcomes and normalized glottal gap area. For those with a complaint of aspiration, the Eating Assessment Tool (EAT-10) questionnaire and Penetration-Aspiration Scale (PAS) were also evaluated.ResultsForty-one patients were included (26M:15F; age range 32 to 80 years old, mean age 58.7). Clinical voice outcomes and glottal closure were significantly improved in all patients, as well as EAT-10 score (16.22 ± 11.83 at pre-IL and 10.83 ± 11.17 at post-IL, P = .008) and PAS [2 (IQR 1.25, 2) at pre-IL and 1 (IQR 1, 2) at post-IL with 20 mL bolus, P = .02; 2 (IQR 2, 4) at pre-IL and 2 (IQR 1, 2) at post-IL with cup-sipping, P = .007]. Twelve patients had ongoing treatment/systemic diseases, who had significant improvement in voice and glottal closure but not in PAS. MCoughP was significantly increased in ongoing treatment/systemic diseases (-) group [42.90 ± 20.17 cmH₂O at pre-IL, 51.33 ± 21.15 at post-IL, 95% CI (-16.63, -0.23), P = .04] but decreased in ongoing treatment/systemic diseases (+) group [67.98 ± 40.06 cmH₂O at pre-IL, 55.32 ± 31.68 at post-IL, 95% CI (1.37, 23.97), P = .03].Conclusions and RelevanceIL significantly improved glottal competence and voice outcomes. However, increased volitional cough pressure and improved swallowing safety were only demonstrated in patients without ongoing treatment or systemic diseases. Patient's general condition may contribute to the observed effect of IL on dysphagia. Rehabilitation to optimize cough strength and prevent aspiration is beneficial for patients with deteriorating general conditions.

ImportancePhonosurgical treatments with photoangiolytic lasers, including blue light lasers, are increasingly common, yet effects on vocal fold oscillation patterns post-surgery are not fully understood.ObjectiveThe primary objective was to investigate changing oscillation patterns and recovery time of vocal fold oscillation after blue light laser phonosurgery in patients with unilateral vocal fold pathology.DesignProspective observational study following the STROBE guidelines, reporting pre- and post-intervention outcomes.SettingThe study was conducted in a clinical phonosurgical department specializing in vocal fold pathology.ParticipantsEight patients with unilateral vocal fold pathology were included. Eligibility was determined based on the necessity for phonosurgery.Intervention or ExposuresEach patient underwent phonosurgical treatment using a blue light laser. Vocal fold function was assessed preoperatively, 2 hours after surgery, 24 hours post-surgery, and 3 weeks following surgery. For the assessment, the subjects phonated on the vowel /i/ at a comfortable pitch and loudness.Main Outcome MeasuresHigh-speed videolaryngoscopy, electroglottography, and audio recordings were used to assess changes in vocal fold oscillations. Main metrics included amplitude symmetry index, jitter, cepstral peak prominence, and Open Quotients.ResultsTwo hours after surgery, an impairment in vocal fold oscillations on the treated side was observed, with a decrease in amplitude symmetry and an increase in electroglottographic jitter. Cepstral peak prominence was reduced, suggesting early effects on vocal fold vibration quality. By 24 hours and 3 weeks post-surgery, most parameters returned to preoperative values. However, the Open Quotient remained lower than pre-surgery levels at the 3-week follow-up, indicating a lasting change in glottal function.ConclusionsVocal fold oscillation recovers relatively quickly after blue light laser treatment, generally returning to baseline within 24 hours.RelevanceThis study highlights the temporary nature of vocal fold impairments following blue light laser surgery, providing insights for patient recovery expectations and voice rest recommendations.Clinical TrialGerman Clinical Trials Register, number DRKS00035411 https://www.drks.de/DRKS00035411.

ImportanceThere are few studies comparing the various surgical approaches for the resection of parapharyngeal space tumors (PPSTs).ObjectiveTo compare surgical outcomes between transoral approaches (conventional transoral approach, endoscopic-assisted transoral approach, and transoral robotic surgery) and external approaches (EAs) in treating PPSTs.DesignSystematic review with meta-analysis.SettingEmbase, MEDLINE, CINAHL, Cochrane, and Web of Science databases were searched until August 2024. Findings were reported as per the PRISMA guidelines.ParticipantsAdult patients with PPST.InterventionsSurgical tumor resection using external or transoral approaches.Main Outcomes and MeasuresOverall effect size for primary outcomes (overall, neurological, non-neurological postoperative complications, and recurrence rates) was presented as event rate, while secondary outcomes (intraoperative bleeding, operation time, and hospitalization duration) were presented as mean differences (MDs).ResultsForty-eight studies involving 1728 patients with PPST were included. EAs were associated with higher incidences of overall [0.40 (0.32-0.48) vs 0.11 (0.08-0.15)] and neurological [0.30 (0.22-0.38) vs 0.05 (0.03-0.07); P < .0001] postoperative complications than transoral approaches (P < .0001 for both) with no significant difference in non-neurological complications. In addition, transoral approaches were associated with significantly fewer postoperative complications than EAs for benign [0.12 (0.22-0.35) vs 0.39 (0.29-0.48); P < .0001], malignant [0.17 (-0.08- 0.41) vs 0.63 (0.30-0.95); P = .03], and prestyloid [0.11 (0.06-0.17) vs 0.39 (0.22-0.05); P = .001] but not poststyloid tumors. Furthermore, transoral approaches were associated with significantly lower intraoperative blood loss (MD: -104.30 mL; P < .00001) and shorter hospitalization (MD: -1.70 days; P = .002) compared to EAs.ConclusionTransoral surgical approaches may be safe and feasible surgical treatments for selected patients, particularly in the prestyloid compartment, when performed in centers with expertise in advanced transoral surgery. Compared to EAs, these approaches had fewer postoperative neurological complications, less intraoperative bleeding, and shorter hospitalization.

ImportanceSingle-entry models (SEMs) can decrease wait times by placing patients in a common queue to see the first available physician. SEMs may be suitable to manage wait times in pediatric otolaryngology; however, understanding is lacking on stakeholder perceptions, and no previous studies have evaluated SEMs specifically for pediatric otolaryngology patients.ObjectiveTo evaluate the views of referring physicians and otolaryngologists on the role of SEMs in managing surgical backlogs for high-volume procedures, and to investigate their recommendations for optimal SEM design and implementation.DesignA qualitative study using semi-structured interviews (according to COREQ and SRQR guidelines).SettingPrimary care and referral settings across Ontario, Canada.ParticipantsTwelve referring physicians who refer to pediatric otolaryngologists and 11 otolaryngologists were recruited through purposive sampling. Eligibility criteria included physicians that work in Ontario.Intervention or ExposuresThis study investigated the perceptions of referring physicians and otolaryngologists on the concept of implementing SEMs for pediatric otolaryngology.Main Outcome MeasuresReferring physicians' and otolaryngologists' perceptions of SEMs as a method of managing wait times in pediatric otolaryngology.ResultsFour thematic domains, each with subdomains, were identified: (1) perceived value of SEMs; (2) operational design and digital integration; (3) evidence and resourcing; and (4) adoption, scope, and system pressures.ConclusionsSEMs are viewed as a viable option to address the surgical backlog in pediatric otolaryngology, from the perspective of referring physicians and otolaryngologists.RelevanceImplementation of an SEM should consider ease of use, adequate support resources, strong and regular communication with all stakeholders, long-term funding, and transparency.

ImportancePeripheral blood inflammatory indices provide a noninvasive and cost-effective means to assess systemic inflammation. This study highlights the potential of pan-immune-inflammation value (PIV) as a reliable biomarker for obstructive sleep apnea (OSA) severity, with implications for clinical risk stratification.ObjectiveTo evaluate the association between peripheral blood inflammatory markers and OSA severity and identify predictive biomarkers for disease classification.DesignProspective observational study.SettingSingle tertiary academic medical center (Peking University Third Hospital), outpatient sleep clinic.Participants266 adults with snoring (18-70 years) undergoing sleep monitoring, laryngoscopy, and blood tests. Exclusion criteria included recent infection, systemic illness, surgery, or pregnancy.Intervention or ExposuresNo therapeutic intervention was performed. Exposures included varying severities of OSA and soft palate obstruction assessed by the Müller maneuver. Inflammatory indices (PIV, SIRI, SIL, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio [MLR], and platelet-to-lymphocyte ratio) were calculated from routine blood parameters.Main Outcome MeasuresThe primary outcome was the association between inflammatory indices and OSA severity as measured by apnea-hypopnea index (AHI). Secondary outcome was the correlation between inflammatory markers and soft palate-level obstruction.ResultsPIV and SIRI were significantly elevated in severe OSA cases (P = .001 and P = .012, respectively). PIV was independently associated with AHI severity (OR = 1.010, 95% CI [1.003, 1.017]). PIV and SIRI positively correlated with AHI (r = .236 and r = .218, both P < .001). MLR, PIV, and SIRI levels increased with greater soft palate collapse, though not independently predictive in multivariate analysis.ConclusionsPIV is an independent, accessible biomarker for assessing OSA severity. Composite indices (PIV, SIRI) may better reflect systemic inflammation than traditional single markers and could complement clinical phenotyping of OSA.RelevanceThese findings support the use of composite inflammatory indices in OSA phenotyping and prognosis. Future studies should investigate inflammation-targeted strategies and validate these biomarkers in larger, multicenter cohorts.Level of Evidence:3.

ImportanceThe role of artificial intelligence (AI) within medicine has increased exponentially over the last decade. However, adoption across medical specialties remains variable, influenced by institutional support, availability of tools, and concerns about accuracy, privacy, and legal liability. Addressing these barriers is necessary to achieving the full clinical capacity of AI.ObjectivesThis study aimed to explore current AI usage patterns among pediatric otolaryngologists and highlight perceived benefits and barriers to adoption.DesignCross-sectional survey design.SettingAll aspects of the present study were conducted remotely, with the survey link being distributed within a private group chat.ParticipantsParticipants were recruited via an international pediatric otolaryngology WhatsApp group chat. Admission is through invitation only.Intervention or ExposuresThe survey sought to characterize a variety of themes regarding AI, including utilization patterns, attitudes, motivational factors and barriers to adoption, and extent of institutional support.Main Outcome MeasuresResponses were evaluated using chi-squared tests and descriptive statistics.ResultsSurvey responses were analyzed from 50 individuals, reflecting a response rate of 15.2%. More than half of survey respondents (60.9%, n = 28/46) use AI in practice, relying on tools like ChatGPT, iScribe, and Gemini to improve workplace efficiency (71.4%, n = 20/28) and address administrative burdens (64.2%, n = 18/28). Despite current adoption of AI, participants identified a lack of institutional guidelines (66.7%, n = 30/45) and support (54.3%, n = 25/47) as major barriers to widespread integration across the subspecialty. No statistically-significant association was found between age and likelihood of AI adoption (P = .095) nor was between geographic region and likelihood of AI adoption (P = .505).ConclusionsPediatric otolaryngologists are interested in and enthusiastic about AI tools. This study highlights prominent institutional and educational gaps, limiting widespread integration.RelevanceThe findings guide future efforts to support AI adoption in pediatric otolaryngology through tailored training, policy, and institutional support.

ImportanceHypopharyngeal squamous cell carcinoma (HPSCC) is an aggressive cancer with poor outcomes. Neoadjuvant therapy (NAT) may allow organ preservation, but determining safe surgical margins after NAT is a critical challenge.ObjectiveTo evaluate the safety of reduced surgical margins after neoadjuvant tislelizumab and afatinib in locally advanced HPSCC by comparing pathological margins to an upfront surgery control group.DesignProspective, single-center pilot cohort study.SettingTertiary referral center in Western China.ParticipantsForty-one patients with locally advanced HPSCC; 32 received NAT (treatment group), and 9 served as an upfront surgery control group.Intervention or ExposuresTreatment group: 2 cycles of neoadjuvant tislelizumab plus 6 weeks of afatinib. Control group: upfront surgery. Both groups underwent resection with a 1.5 cm naked-eye surgical margin.Main Outcome MeasuresPrimary outcomes were minimal peripheral surgical margin (MPSM) and minimal deep surgical margin (MDSM). Secondary outcomes included radiological (RECIST v1.1) and pathological tumor response.ResultsThe NAT group had a 20/32 (62.5%) radiological objective response rate and a 16/32 (50.0%) major pathological response rate [including 9/32 (28.13%) pathological complete response]. The mean MPSM was significantly greater in the treatment group versus control [3.38 mm vs 1.71 mm; 95% Confidence interval (CI): 0.10-3.24; P = .038]. The mean MDSM was also significantly greater in the treatment group versus control (2.09 mm vs 1.04 mm; 95% CI: 0.12-1.97; P = .029).ConclusionsCombined immune-targeted NAT effectively downstages HPSCC. The significantly larger pathological margins observed support that reducing clinical surgical margins after this regimen is generally safe.RelevanceThis NAT regimen may allow for less extensive resections, facilitating laryngeal preservation and improving quality of life without compromising oncologic safety. Larger validation studies are needed.

ObjectiveGraft outcomes and complications were compared in patients who received a cartilage-perichondrium composite graft via perichondrium reinforcement (CPPR) and those treated using only a cartilage-perichondrium composite graft underlay (CPGU) technique, including raising a tympanomeatal flap, in the repair of a subtotal perforation.Materials and MethodsPatients with subtotal perforations were semi-randomly allocated to the CPPR and CPGU groups. The graft success rate, hearing outcomes, operation times, postoperative visual analog scale (VAS) values, and complications were compared for up to 6 months postoperatively.ResultsThe sample consisted of 67 ears from 67 patients. The mean operation time was 33.1 ± 2.8 min in the CPPR group and 56.2 ± 1.8 min in the CPGU group. At 6 months postoperatively, the VAS scores were 1.4 ± 0.9 and 3.7 ± 1.2, and the graft success rates were 97.0% and 88.2% (P = .371), respectively. There were no significant differences in the mean gain in the air-bone gap (16.2 ± 5.3 vs. 14.7 ± 6.2) between the two groups, but hearing improvement was greater in the CPPR group. Ear fullness was reported by 21.2% patients in the CPPR group and 91.2% of patients in the CPGU group. Temporary hypogeusia developed in 3.0% of patients in the CPPR group and 38.2% of those in the CPGU group. Myringitis was seen in 9.1% patients in the CPPR group and 2.9% in the CPGU group.ConclusionIn patients undergoing subtotal perforation repair, the 6-month graft outcome in patients treated with the perichondrium reinforcement technique without raising a tympanomeatal flap and external ear canal packing was similar to that of patients who underwent a flap-raising technique. The advantages of the perichondrium reinforcement technique are that it is simple, time-saving, and minimally invasive, with less ear fullness and better hearing recovery.

ImportanceNasopharyngeal cancer (NPC) is a strikingly age-specific and region-specific malignancy whose disproportionate and changing burden among younger people in the Western Pacific Region (WPR) has yet to be comprehensively quantified.ObjectiveThis study aimed to evaluate the burden and trends of NPC in individuals under 55 years in the WPR from 1990 to 2021 and project future trends up to 2035.DesignPopulation-based study.PopulationIndividuals under 55 years in the WPR, as part of the Global Burden of Disease Study 2021, spanning from 1990 to 2021.Main Outcome MeasuresAge-standardized rates of incidence, mortality, prevalence, disability-adjusted life years (DALYs), and average annual percentage change (AAPC) of nasopharyngeal cancer among people younger than 55 analyzed by regions and countries in the WPR from 1990 to 2021.ResultsBetween 1990 and 2021, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDLR) of NPC in individuals under 55 years in the WPR significantly decreased (all P < .001), whereas the age-standardized prevalence rate (ASPR) increased (P < .001). The NPC burden increased with age, peaking in the 50 to 54 age group, and was higher in males. Singapore exhibited the highest age-standardized incidence rate (ASIR) but low ASMR and ASDLR and China showed a decline in the ASIR and the ASMR, though the ASPR increased (all P < .001). Aging and population growth contributed to the rising NPC burden in the region. From 2022 to 2035, the ASIR is projected to rise to 2.85 per 100,000 [AAPC 95% CI = 2.04% (1.97%, 2.09%), P < .001], and the ASPR is expected to increase to 18.54 per 100,000 [AAPC 95% CI = 2.36% (2.24%, 2.44%), P < .001].ConclusionThe growing NPC burden among young populations in the WPR underscores the need for countries to adopt effective prevention strategies based on the experiences of peers with similar demographic profiles.